terone also have more trouble producing or maintaining an erection. Several small studies have shown that testosterone sup- plementation in older men results in both increases in libido and in a higher sense of well-being and satisfaction. Weight gain in elderly women is fre-
quently blamed on the hormonal and metabolic changes caused by menopause. Similarly, decreased testosterone is linked to increased body fat, especially “visceral” fat. Visceral fat is also called abdominal fat or organ fat. It is the fat that is located in- side the abdomen instead of just under the skin where most fat deposits are located. Packed in among and around the abdomi- nal organs, visceral fat is associated with a much greater risk of cardiovascular dis- ease, diabetes, hypertension, atherosclero- sis and premature death. Any doctor that sees middle-aged
men is asked: “Do men have male meno- pause?” or: “Does male menopause exist?” Because of the very different ways that men and women’s bodies change the pro- duction and availability of sex hormones, these are really the wrong questions. The question that we should ask is: “Should men be evaluated for sex-hormone chang- es in later life?” The answer to this ques- tion is a very firm and unequivocal: “Yes.” Without proper evaluation of andro-
gen levels, many treatable symptoms will go unaddressed. With proper evaluation, men can be treated in ways that will im- prove general health, longevity, and qual- ity of life.
Unfortunately, most clinicians either
do not recognize the symptoms of tes- tosterone deficiency or believe that these symptoms are “normal aging.” When doc- tors miss addressing testosterone deficien- cy, they cheat their patients of powerful treatment options. Complicating evaluation and treat-
ment of androgen deficiency, however, is the difficulty in measuring or defining what is an abnormally low level. Men’s testosterone levels in later life are variable and poorly-defined. Among the issues: there are multiple protocols for testing an- drogens, each with different reference val- ues, there are different androgen fractions (free testosterone vs. bioavailabile testos- terone, etc.) that can mask the amount ac- tually available for use by the body, and the reference standards for the “normal” range are incredibly broad. The biggest issue in simply using blood
tests to determine if a man is testosterone deficient is that the blood levels will vary greatly from one day to the next. Even if
the test is drawn the same time of day on successive days, the blood levels of testos- terone can be very different. This is why a full evaluation that considers the combina- tion of clinical symptoms and blood tests is so important. Just as with estrogen replacement ther-
apy in women, however, there has been a great deal of controversy about possible hormone replacement therapy in men. The chief concern has been worries that testos- terone replacement could stimulate heart disease or prostate cancer. Fortunately, the concerns for both negative side-effects appear to be overblown. As said, there is growing evidence that testosterone can help protect the heart from cardiovascular disease. The case of prostate cancer is a bit
more complicated. Many treatments for prostate cancer attempts to reduce testos- terone to suppress tumor growth. Obvi- ously, giving testosterone to a man with a prostate tumor is therefore not an option. The question has been: will testosterone supplements provoke prostate cancer? Fortunately, the answer appears to be, “No.” Increased testosterone levels are not linked to higher rates of prostate cancer or more deaths from prostate cancer. In fact, it is quite the opposite. Men with higher amounts of testosterone show lower inci- dence and mortality for prostate cancer, as well as for cardiovascular disease and for all causes of death. The decline in late-life androgen pro-
duction is a very real and very treatable phenomenon. Unfortunately, 50 years of debate about whether there is such a thing as “male menopause” has obscured these hormonal changes. There is a growing re- alization that proper evaluation and treat- ment of testosterone deficiency is both appropriate and beneficial for many men. For optimal results, I recommend seeking out a physician experienced in bioidenti- cal hormone replacement therapy within a broader program addressing overall life- style modification and enhancement.
Desmond Ebanks, MD is a board certified internal medicine physician specializing in age management medicine; a science- based approach to preventive wellness, bioidentical hormone modulation and optimizing health for men and women at Alternity Healthcare, LLC in West Hartford, CT. He can be reached at 860-561-2294 or
www.alternityhealthcare.com. See ad on page 2.
www.naturalnutmeg.com June 2010
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